Gazdasági Ismeretek | Minőségbiztosítás » John Lord - An Initial Framework for Quality Assurance, It is About People and Relationships

Source: http://www.doksinet An Initial Framework for Quality Assurance: It’s About People and Relationships John Lord* March, 2005. * John Lord is a researcher and human services consultant from KitchenerWaterloo, Ontario. He was a founder and first director of the Centre for Research and Education in Human Services, and has worked with numerous organizations in Canada and in other countries. Source: http://www.doksinet We live in an era of accountability. Governments and other funders of human services want to know that their money is well spent and that programs and services are of high quality. Unfortunately, most talk of “quality assurance” tends to focus only on ways that service agencies can promote accountability and service quality. In the world of quality assurance, it is not surprising that accreditation and licensing receive a lot of attention, while more informal and relationship oriented approaches are often neglected. We must first recognize that what

constitutes quality in the provision of supports for vulnerable citizens is not easy to determine. First of all, there is a difference between quality of life and quality support services. Quality of life can be understood as people experiencing a meaningful life, having valued resources and valued roles, and being connected with family, friends and the wider community. Quality services and supports may or may not lead to these quality of life outcomes. We are learning that quality of life must be built intentionally, with mechanisms and approaches that are effective and accountable. Thus, my approach in this paper is to begin to identify elements of quality supports and community services that can enhance quality of life. To begin to consider quality, we must start with assumptions and a framework, and embrace the idea that ensuring quality requires a multifaceted approach. I begin the development of this initial framework for quality assurance with four assumptions that are

increasingly being supported by research and everyday practice: ♦ People who are vulnerable because of disability or aging often feel powerless, so anything that can be done to strengthen and empower families and individuals will contribute to quality. (Research shows that people who experience personal control and participation tend to be healthier and have a better quality of life). 2 Source: http://www.doksinet ♦ People with disabilities are often isolated, so anything that can be done to reduce isolation and increase networks and relationships will contribute to quality. (Research shows that people with strong personal networks and support tend to be healthier and have a better quality of life). ♦ Each person that receives support has his/her own unique strengths and needs, so the more that supports are individualized and tailored to the person, the greater the contribution to quality. (Research shows that people who receive individualized supports experience better

quality services than people who receive congregate or standardized services). ♦ Enhancing quality is more about the personal values and principles of leaders and people providing support than it is about external criteria applied to a service or agency. (Research shows that people change when they are engaged and committed to change. Thus, one way to change the quality of supports involves training and support for the people providing the support). These four assumptions ground us in approaches to quality that are based on ways to shift power and control to the person and their family, ways to build networks and relationships, ways to individualize supports, and ways to engage and train workers. In addition to embracing these assumptions, any framework designed for quality assurance needs to recognize that quality can only be enhanced by paying attention to five levels of involvement: individual, services and programs, family and friends, community, and policy. For each of these

levels, I will briefly highlight some ways to enhance quality and point to questions that need to be considered when trying to build quality. 3 Source: http://www.doksinet Individual Thinking about quality supports should begin and stay focused on the person receiving supports. Supports should strengthen the person’s selfdetermination and choices Several things have been shown to strengthen quality with the person: ♦ Individuals experience several quality of life indicators, including having genuine choice and voice, experiencing valued social roles, having adequate resources, participating in community life, and having relationships with family and friends. ♦ There is evidence that the quality of supports and services are designed to contribute to quality of life. ♦ Independent planning support provides facilitation, listening, network building, and planning with the person and other people that care about the person. ♦ Supports are individualized and tailored for

the person, based on the person’s strengths, gifts, and needs, and focused on enhancing quality of life. ♦ Support workers and others in the person’s life show deep respect and understanding for the individual. ♦ Opportunities are provided for individuals to form and participate in peer support and self-advocacy groups, where personal voice and participation can happen unconditionally. There are obviously many more principles that can enhance quality with the individual, but consistently these six have the most impact. 4 Source: http://www.doksinet Services and Programs Many traditional services have institutionalized systems that disempower vulnerable people. Any efforts to build quality assurance within service systems must pay attention to quality of life of individuals and consciously shift resources and supports to new approaches that focus on empowerment of individuals and families. Several things have been shown to strengthen quality of supports from the

perspective of service providers: ♦ Education is provided for users to know their rights and vehicles are provided for people to express their concerns about rights violations. ♦ Person-centred planning support is provided in ways that strengthens people’s self-determination and choices. ♦ Supports are individualized, tailored for the person, and focused on ways to enhance quality of life. ♦ Consumer participation is highly valued and supported in regard to both personal concerns and issues related to service planning and implementation. ♦ All staff and support workers are learning to give up control over the people they support, and workers show deep respect and understanding for the individuals they support and their quality of life. ♦ The organization that provides supports and services is highly ethical and is open to learning about new ways to organize supports that shift resources to individuals, families, and communities. 5 Source: http://www.doksinet

There are obviously many more principles that can enhance quality within service systems, but consistently these six have the most impact. Family and Friends For many people, family is a vital part of their lives. For others, family is less important, but friends may play a role similar to family. Regardless, we do know that people need relationships in their lives in order to have a decent quality of life. Several things have been shown to strengthen quality with family and friends: ♦ Intentional efforts are made to connect or re-connect people with extended family members, potential friends, and other informal relationships. ♦ Families are supported and strengthened by receiving appropriate information and by having choices in the way that individualized supports are provided. ♦ Independent planning support provides facilitation, listening, network building, and planning with the person and their family and friends. ♦ Families who have members who live in services

feel welcomed in those services, and are invited to participate in ways that the person chooses. ♦ Families participate in ongoing reviews and evaluations of any support arrangements. There are obviously many more principles that can enhance quality with the families, but consistently these five have the most impact. 6 Source: http://www.doksinet Community As citizenship increasingly becomes a key part of any framework for how we provide supports to people, the role the community plays in contributing to quality becomes paramount. Several things have been shown to strengthen quality and reduce isolation from the perspective of community: ♦ Ways to intentionally strengthen people’s contribution to their community are well developed. ♦ People are welcomed in a range of community settings and within community groups of common interest. ♦ People know their neighbours and are known in places in their neighbourhood, such as stores and recreation settings. ♦ The

community recognizes that all citizens have gifts and there are many avenues for people to express those gifts. ♦ One-to-one programs focus on connecting people with their community and relationship building, and they do things that sustain those relationships over time. There are obviously many more principles that can enhance quality within communities, but consistently these five have the most impact. Policy Provincial policy is vital in determining the degree to which disability supports are of high quality or not. In Unison, the federal/provincial agreement on disability supports, highlights the need for supports to be portable, flexible, and individualized. Government policy can assist this process of change toward new ways of working. 7 Source: http://www.doksinet Several policies have been shown to strengthen quality of supports and quality of life: ♦ All resources provided to vulnerable individuals are portable, so that families and consumers can take their

resources wherever they want; similarly, housing and supports are de-linked, so that individuals can create their own homes (with affordable housing as needed), with the individualized supports they may need to live in the community. ♦ Infrastructure supports, such as independent planning support, are provided to individuals and families, so that facilitation is available to assist people to build a quality of life in community. ♦ Flexible funding is available for those individuals and families who do not want services through an agency; this funding may involve direct funding to the individual/family or it may be indirect, with funding going through a transfer payment agency of choice. ♦ There is capacity and funds available for innovation, so that families and service providers are encouraged to try new things and develop quality approaches based on best practice research. ♦ Consumers and families are mandated to participate in local, regional, and provincial planning

and quality assurance safeguarding. ♦ A provincial office gathers and disseminates information, both qualitative and quantitative, on services, supports, satisfaction, and other quality indicators, so that provincial and regional planning is based on needs and equity. There are obviously many more policies that can enhance quality, but consistently these six have the most impact. 8 Source: http://www.doksinet It’s about People and Relationships When designing approaches to quality assurance, it is tempting to focus only on mechanisms that will change systems. While several approaches and mechanisms I have proposed will certainly make a difference in the lives of people, we must remember that systems are operated by people. Quality assurance is best enhanced by good people making the right decisions. Personal commitment to quality means we all have to be willing to look at what we are doing. Self-criticism and openness to learning go a long way toward enhancing quality.

Similarly, being aware that quality supports and services must be designed to enhance quality of life is an important understanding. Quality assurance is really about people and relationships. It is making sure that vulnerable citizens have family and friends in their lives. It is about building relationships that matter to the person, and connecting that person’s interests with people and places in the wider community. Ultimately, quality assurance is about how well we facilitate people’s dreams and desires for citizenship. This initial framework for quality assurance is also a call for ethical decision-making related to quality supports that enhance quality of life. The principles and policies outlined here are consistent with new paradigm, best practice research. The positive outcomes of person-centred initiatives that are grounded in these principles give us hope that reflection and action on this initial framework can make a difference in the lives of citizens who require

quality support or services. 9 Source: http://www.doksinet Further Reading Michael Kendrick (1994). Thirty Elements of Service Quality, Progress, Vol. 2, Commonwealth of Massachusetts, Department of Mental Retardation. John Lord, Barbara Zupko, & Peggy Hutchison (2000). More Choice and Control for People with Disabilities. Toronto: Ontario Federation for Cerebral Palsy. John O’Brien & Connie Lyle O’Brien (no dates). Options for Action and Members of Each Other. Toronto: Inclusion Press Rebecca Renwick, Ivan Brown, & Mark Nagler (1996). Quality of Life in Health Promotion and Rehabilitation: Conceptual Approaches, Issues and Applications. Thousand Oaks, CA: Sage Publications Margaret Somerville (2000). The Ethical Canary: Science, Society, and the Human Spirit. Toronto: Penguin Books This document has been published by the Individualized Funding Coalition for Ontario a part of the “Opening the Doors to Community” series. March, 2005 10